title: Known and missing left ventricular ejection fraction and survival in patients with heart failure: a MAGGIC meta-analysis report.
abstract: OBJECTIVE
  Treatment of patients with heart failure (HF) relies on measurement of LVEF. However, the extent to which EF is recorded varies markedly. We sought to characterize the patient group that is missing a measure of EF, and to explore the association between missing EF and outcome.
  
  
  RESULTS
  Individual data on 30 445 patients from 28 observational studies in the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) project were used to compare the prevalence of co-morbidities and outcome across three groups of HF patients: those with missing EF (HF-mEF), reduced EF (HF-REF), and preserved EF (HF-PEF). A total of 29% had HF-mEF, 52% HF-REF, and 19% HF-PEF. Compared with patients in whom EF was known, patients with HF-mEF were older, had a greater prevalence of COPD and previous stroke, and were smokers. Patients with HF-mEF were less likely to receive evidence-based treatment than those with HF-REF. Adjusted mortality in HF-mEF was similar to that in HF-REF and greater than that in HF-PEF at 3 years [HF-REF, hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.95-1.12); HF-PEF, HR 0.78, 95% CI 0.71-0.86].
  
  
  CONCLUSIONS
  Missing EF is common. The short- and long-term outcome of patients with HF-mEF is poor and they exhibit different co-morbidity profiles and treatment patterns compared with patients with known EF. HF patients with missing EF represent a high risk group.
authors.affiliation: Department of Medicine, The University of Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.forename: Iain B
authors.initials: IB
authors.lastname: Squire
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.forename: Nikki J
authors.initials: NJ
authors.lastname: Earle
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000592:standards*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D013318:Stroke Volume
keywords: Ejection fraction; Heart failur; Meta-analysis; Missing data; Outcome